Bulky, barrel-shaped cervical carcinoma (stages IB, IIA, IIB): the prognostic factors for pelvic control and treatment outcome.

The purpose of this study was to assess the prognostic factors for pelvic control and the treatment outcome in bulky, barrel-shaped cervical carcinomas. Between September 1980 and December 1992, 65 patients with stage IB or stage IIA-B carcinoma of the uterine cervix classified as barrel-shaped or concentrically expanded (i.e., at least 5 cm in greatest diameter) were treated with curative intent. Forty patients had stage IB or stage IIA carcinoma (according to the classification of the International Federation of Gynecology and Obstetrics [FIGO]), and 25 patients had FIGO stage IIB carcinoma. Seventy-two percent of the patients were treated with radiotherapy (RT) alone and 28% with radiotherapy followed by extrafascial hysterectomy (RT + S). The median follow-up time of surviving patients was 68 months (range 33-172). Survival and control rates were calculated by the Kaplan-Meier method. The 10-year actuarial pelvic control rate was 75% for all patients. The likelihood of pelvic control was not affected by FIGO stage, tumor size, patient's age, histologic features, or treatment modality (RT vs. RT + S). The extent of tumor regression following external beam radiotherapy correlated with the likelihood of local control (p = 0.02). For patients treated with RT alone, increased brachytherapy dose was associated with an increased likelihood of local control. The 10-year actuarial overall and cause-specific survival rates were 53% and 68%, respectively, and did not differ significantly between treatment groups. It is concluded that for most patients with bulky cervical carcinoma, RT alone provides good local control and survival. However, for patients with tumors that respond poorly to external beam radiotherapy, local control and survival are poor. More aggressive treatment protocols should be considered for these patients. The routine use of adjuvant hysterectomy is not recommended.